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Prognostic Value of Circulating Plasma Cells in Monoclonal Gammopathy of Undetermined Significance

From the Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN

Address reprint requests to T.E. Witzig, MD, 620 Stabile Bldg, Mayo Clinic, Rochester, MN 55905; e-mail: witzig{at}mayo.edu

PURPOSE: Monoclonal gammopathy of undetermined significance (MGUS) progresses to multiple myeloma or another related plasma cell disorder (PCD) at a rate of approximately 1% per year. Identification of patients with MGUS at high risk of progression will allow development of preventive strategies. We studied the prognostic value of circulating plasma cells (PCs) in patients with MGUS to predict progression.

PATIENTS AND METHODS: Patients were eligible for this retrospective analysis if they were seen at the Mayo Clinic between 1984 and 1997, were diagnosed with MGUS, and had an analysis of the peripheral blood for circulating PCs by the slide-based immunofluorescence method. Patients were observed for progression to another PCD.

RESULTS: Three hundred twenty-five patients were eligible and 63 (19%) had circulating PCs. Patients with circulating PCs were twice as likely (hazard ratio, 2.1) to experience progression to another PCD (most commonly myeloma), compared with those without circulating PCs (95% CI, 1.1 to 4.3; P = .03). In patients with circulating PCs, the median progression-free survival was 138 months compared with a median not yet reached for those without circulating PCs (P = .028). The median overall survival also was shorter for those with circulating PCs. Other factors with prognostic value were high levels of M protein and non–immunoglobulin G heavy-chain type.

CONCLUSION: The presence of circulating PCs, especially when combined with other known prognostic factors such as M protein concentration and immunoglobulin isotype, identify a group of individuals with MGUS at higher risk of progression to overt multiple myeloma.

Supported by grant Nos. CA62242, CA85818, CA93842, CA65125, and CA100080 from the National Cancer Institute, Bethesda, MD. S.V.R. is supported by the Multiple Myeloma Research Foundation and the Goldman Philanthropic Partnerships. S.V.R. and R.F. are also supported by Leukemia and Lymphoma Society Translational Research Awards.

Presented in part at the Annual Meeting of the American Society of Hematology, December 6-9, 2003, San Diego, CA.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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